SURGICAL TREATMENT OF CAROTID BODY TUMORS — A SINGLE CENTER EXPERIENCE AND LITERATURE REVIEW
Keywords:Carotid body tumors, urgical treatment, Surgical treatment, Pre-operative embolization
Introduction: Carotid body tumors (CBT) are rare (1–2/100.000) slow-growing, hipervascular neuroendocrine tumors, originate from the neural crest. Their exact cause is unknown. Most are sporadic, but a subset (25%) are associated with hereditary paraganglioma syndrome. Complete surgical removal is the treatment of choice for all CBTs.
Methods: This is a retrospective study of patients with CBT, who were treated at our institution between 2012 and 2018 and a literature review.
Results: Over the last 6 years, 13 patients were treated for CBTs in our center (7 female, 6 male), who were aged 46 years (range 14–72 years). Three (23%) of the tumors were Shamblin I, eight (61,5%) Shamblin II and two (15,5%) Shamblin III. The median tumor diameter was 3,6 cm (range from 2,5 to 6,6cm). We performed preoperative embolization with micro coils in 5 patients (39%), 2 days before surgery.Two patients (40%) presented with Shamblin's III tumors (one with cranial extension) and 3 (60%) had tumor >5cm, Shamblin II. There were no postembolization strokes, TIAs or access site hematomas. All 13 CBTs tumors (including large tumors, extended cranially and Shamblin's III) were treated with resection alone (100%), without need for arterial resection or reconstruction. Average blood loss was 130 mL (range from 100 to 180 mL). In this study the overall rate of complications was 7% (1 patient) who had permanent hoarseness due to vagus nerve resection (vagus sacrificed due to tumor involvement), there were no cases of stroke, TIA or hematoma . There were no mortalities in the perioperative period or during follow-up.
Conclusion: CBTs are rare and surgical excision can be very demanding and laborious. From our experience, pre-operative embolization is safe and may be of value in large and Shamblin III tumors.
2. Amr G, Ahmed S, et al. Carotid body tumors: a review of 25 years experience in diagnosis and management of 56 tumors. Ann Vasc Dis 2014; 2: 292-299
3. Jennifer D, Marvin A, William B, Clifford B, Terry L. Surgical Management of Carotid Body Tumors: A 15-Year Single Institution Experience Employing an Interdisciplinary Approach. Baylor University Medical Center Proceedings 2016, 29:1, 16-20
4. DuBois J, Kelly W, McMenamin P, Macbeth GA. Bilateral carotid body tumors managed with preoperative embolization: a case report and review. J Vasc Surg. 1987 Apr;5(4):648-50
5. Lim JY, Kim J, Kim SH, Lee S, Lim YC, Kim JW, Choi EC. Surgical treatment of carotid body paragangliomas: outcomes and complications according to the shamblin classification. Clin Exp Otorhinolaryngol. 2010 Jun;3(2):91-5.
6. Dan M, Min L, Hua Y, Xiaogan M, Chaojun Z. Diagnosis and surgical treatment of carotid body tumor: A report of 18 cases. Journal of Cardiovascular Disease Research 2016; 3: 10.4103/0975-3583.70905
7. Singh D, Pinjala RK, Reddy RC, Satya Vani PV. Management for carotid body paragangliomas. Interact Cardiovasc Thorac
Surg. 2006 Dec;5(6):692-5.
8. Martinelli O, Irace L, Massa R, Savelli S, Giannoni F, Gattuso R, Gossetti B, Benedetti-Valentini F, Izzo L. Carotid body tumors: radioguided surgical approach. J Exp Clin Cancer Res. 2009 Dec 10;28:148.
9. Hallett Jr JW, Nora JD, Hollier LH, et al: Trends in neurovascular complications of surgical management for carotid body and cervical paragangliomas: a fifty-year experience with 153 tumors. J Vasc Surg 1988; 7:284-291.
10. Georgiadis GS, Lazarides MK, Tsalkidis A, Argyropoulou P, Giatromanolaki A. Carotid body tumor in a 13-year-old child: Case report and review of the literature. J Vasc Surg. 2008 Apr;47(4):874-880.
11. Ayhan M, Ahmet Y. Carotid body tumors: a report of three cases and current literature. Vasc disease and therapeutics 2017, Vol2 (5):1-3
12. Gloria K, Peter L et al: New predictors of complications in carotid body tumor resection. J Vasc Surg 2017;65:1673-9
13. Adrienne C, Adel B, et al: Carotid body tumor resection: just as safe without pre-operative embolization. Ann Vsc Surg 2018; 46:54-59
14. Virginia L, Linda R et al: Preoperative embolization of carotid body tumors: when it is appropriate?. Ann Vasc Surg 1996; 10:464-468
15. Kasper GC, Welling RE, Wladis AR, et al: A multidisciplinary approach to carotid paragangliomas. Vasc Endovasc Surg 2006; 40:467-474.
16. Persky MS, Setton A, Niimi Y, Hartman J, Frank D, Berenstein A. Combined endovascular and surgical treatment of head and neck paragangliomas: a team approach. Head Neck. 2002 May;24(5):423-31.
17. LaMuraglia M, Fabian L, Brewster C, Pile-Spellman J, Darling C, Cambria P, et al. The current surgical management of carotid body paragangliomas. J Vasc Surg. 1992 Jun;15(6):1038-44.
18. Jacqueline W, Alice S. Wieneke JA, Smith A. Paraganglioma: carotid body tumor. Head Neck Pathol. ;3(4):303–306
19. Adam P, Thomas B, et al: Impacto f preopeartive embolization on outcomes of carotid body tumor resections. J Vasc Surg 2012; 56:979-89
20. White JB, Link MJ, Cloft HJ. Endovascular embolization of paragangliomas: A safe adjuvant to treatment. J Vasc Interv Neurol. 2008 Apr;1(2):37-41.